Provider Demographics
NPI:1942565957
Name:SCHRAGE, JENNIFER LYNN (LIMHP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:SCHRAGE
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 WILSHIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3365
Mailing Address - Country:US
Mailing Address - Phone:402-416-5037
Mailing Address - Fax:402-467-2769
Practice Address - Street 1:4830 WILSHIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3365
Practice Address - Country:US
Practice Address - Phone:402-416-5037
Practice Address - Fax:402-416-5037
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid